Please complete all the details below for your insurance membership request and allow up to seven business days for your request to be processed. Please complete all required fields! Please enter your contact information Name(*) Invalid Input Organisation(*) Invalid Input Phone(*) Invalid Input Email(*) Invalid Input Member Details First Name(*) Invalid Input Last Name(*) Invalid Input Address(*) Invalid Input Suburb(*) Invalid Input Postcode(*) Invalid Input Phone(*) Invalid Input Email(*) Invalid Input Date of Birth(*) Invalid Input Select your membership option All memberships include access to the gym, group fitness and aquatic facilities(*) 1 month $199 3 months $440 12 months $995 Invalid Input Invoicing Details Organisation to invoice(*) Invalid Input Contact Person(*) Invalid Input Address(*) Invalid Input Suburb(*) Invalid Input Postcode(*) Invalid Input Contact Phone(*) Invalid Input Email(*) Invalid Input Claim Number(*) Invalid Input Membership start date(*) Invalid Input Supporting Documentation If you have any supporting documentation, please upload. Invalid Input Additional comments Invalid Input Submit